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Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2016 Jun 01; Vol. 117 (11), pp. 1735-40. Date of Electronic Publication: 2016 Mar 18. - Publication Year :
- 2016
-
Abstract
- Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Coronary Angiography
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Prognosis
Retrospective Studies
ST Elevation Myocardial Infarction diagnosis
ST Elevation Myocardial Infarction physiopathology
Time Factors
Treatment Outcome
Electrocardiography
Percutaneous Coronary Intervention methods
Recovery of Function
ST Elevation Myocardial Infarction surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 117
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 27062938
- Full Text :
- https://doi.org/10.1016/j.amjcard.2016.03.009